Our Services

  • Infertility Evaluation
  • Infertility Treatment
  • IUI
  • IVF
  • Surrogacy Clinic
  • High Risk Pregnancy
  • Menstrual Problems
  • Other Services

Infertility Evaluation

If male infertility is suspected, a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.

If female infertility is suspected, your doctor may order several tests, including:

  • A blood test to check hormone levels
  • An endometrial biopsy to check the lining of the uterus

Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.

  • Hysterosalpingography (HSG). This procedure involves either ultrasound or X-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and travel up through the fallopian tubes. This enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
  • Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check to see if the fallopian tubes are open at the same time.

Infertility Treatment

Infertility in Men Treatment

Any fertility treatment may be expected to have an effect on semen quality roughly three months after it is started, as this is the length of time required for a single cycle of spermatogenesis, or sperm production. If neither surgical nor medical therapy is appropriate, assisted reproductive technologies are possible.

In choosing a treatment plan, consideration should be given to each couple's long-term goals, financial constraints, and the results of the female partner's evaluation in addition to male factor findings.

 

Specific Therapy

The most successful medical therapy for male infertility involves reversing chemical, infectious or endocrine imbalances. This is called specific therapy, and it is usually successful because treatment is based on the correction of well-defined problems.

Examples of this include:

  • Treatment for acute prostatitis, epididymitis or varicocele
  • The replacement of the pituitary hormones — follicle stimulating hormone (FSH) and leutinizing hormone (LH) — for radiation or surgically induced pituitary disease
  • The administration of testosterone in men with hypoandrogenic hypogonadism

Empiric Therapy

Another kind of treatment, called empiric therapy, attempts to correct rather ill-defined conditions. The use of clomiphene citrate, tamoxifen or ProXeed for low sperm density or motility are examples of this form of therapy.

These treatments often have limited success because the generally intact mechanisms within the body tend to counteract the intended effect. In other words, hormonal treatments based on the principle that "if some hormone is good, then more is better" are destined to failure and should be avoided.

 

Assisted Reproductive Technology

Treating specific illnesses may or may not treat the fertility problem. At least 10 percent of infertility problems are due to unknown causes and another 30 percent are due to problems in both the male and female partners.

In addition to medication and surgical infertility treatments to treat specific health conditions in men and women, a new class of treatments — called assisted reproductive technologies, or ART — has been developed. The most common ART is in vitro fertilization, or IVF, but new procedures can enhance the IVF process or address other infertility conditions. These procedures for men include:

  • Intracytoplasmic sperm injection (ICSI)
  • Sperm extraction procedures, such as:
    • Vasal aspiration
    • Epididymal aspiration
    • Testicular sperm extraction
    • "Mapping" the failing testes
  • Embryo or semen freezing

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection, or ICSI, is a technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The procedure overcomes many of the barriers to fertilization and allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos.

The procedure was first used at UCSF Medical Center in 1994 and the first successful birth achieved with ICSI assistance was in February 1995. UCSF Medical Center was the first San Francisco Bay Area program to achieve a pregnancy and birth with this "miracle" procedure.

The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure requires that the female partner undergo ovarian stimulation with fertility medications so that several mature eggs develop. These eggs are then suctioned through the vagina, using vaginal ultrasound, and incubated under precise conditions in the embryology laboratory. The semen sample is prepared by spinning the sperm cells through a special medium. This solution separates live sperm from debris and most of the dead sperm. The specialist picks up the single live sperm in a glass needle and injects it directly into the egg.

Through the ICSI procedure, many couples with difficult male factor infertility problems have achieved pregnancy. Fertilization rates of 70 percent to 80 percent of all eggs injected are currently being achieved, and pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.

 

Sperm Extraction Procedures

Intracytoplasmic sperm injection has revolutionized the treatment of male infertility. The sperm requirement for egg fertilization has dropped from hundreds of thousands for in vitro fertilization (IVF), to one viable sperm required for ICSI when combined with IVF.

This has led to the recent development of aggressive new surgical techniques to provide viable sperm for egg fertilization from men with low or no sperm count. This also has pushed urologists beyond the ejaculate and into the male reproductive tract to find sperm. Presently, sources of sperm in otherwise azoospermic patients, or those with no ejaculated sperm, include the vas deferens, epididymis and testicle, using sperm aspiration techniques in which the sperm is suctioned from the organ.

Sperm aspiration techniques involve the use of minor surgical procedures to collect sperm from organs within the genital tract. These techniques are indicated for men in whom the transport of sperm is not possible because the ductal system that normally carries sperm to the ejaculate is absent, such as with the congenital absence of the vas deferens, or unable to be reconstructed.

Most recently, sperm has been fairly reliably extracted — 60 percent to 70 percent of the time — from the testes of men with sperm production problems of such severity that no sperm is found in the ejaculatory ducts.

It is important to realize, however, that IVF technology is required to achieve a pregnancy with the vast majority of these extraction procedures, and success rates are intimately tied to a complex and complementary program of assisted reproduction for both partners.

 

Sperm Extraction: Vasal Aspiration

Patients who have congenital or acquired obstruction of the ductal system at the level of the prostate or in the abdominal or pelvic portions of the vas deferens may be candidates for this technique. Patients who have undergone a vasectomy less than five years before also may be candidates.

Vasal aspiration is a brief, same-day operation under local anesthesia. It can be done through a small scrotal incision or through incisionless techniques. Either way, the vas deferens is entered and a syringe is used to suction leaking sperm into a nourishing fluid. More sperm are brought to the opening by gently massaging the epididymis and vas deferens. The recovery period is 24 hours. Aspirated sperm are specially processed and prepared for insemination or IVF.

Of the three extraction procedures, vasal aspiration provides the most "mature" sperm, as they have already passed through the epididymis, where maturation processes occur during normal sperm development. Often, ICSI is not required to achieve a pregnancy. A big benefit of vasal sperm is that it is basically equivalent to ejaculated sperm and thus it can be frozen at the time of surgery to avoid further procedures in the male.

 

Sperm Extraction: Epididymal Aspiration

Epididymal sperm aspiration can be performed in situations in which the vas deferens is either absent or is scarred from prior surgery, trauma or infection. Sperm are directly collected from a single, isolated epididymal tubule (MESA) or by blind needle puncture (PESA) in much the same manner as the vasal procedure. Depending on the length of the epididymis that is available for aspiration, multiple, separate aspiration attempts can be made from one or both testicles.

When 10 to 20 million sperm are obtained, the sperm are processed for fertilization of the partner's eggs. Epididymal sperm are not as "mature" as sperm that have traversed the entire length of the epididymis and reside in the vas deferens and, as a consequence, epididymal sperm require ICSI to fertilize eggs.

Egg fertilization rates of 60 percent to 80 percent and pregnancy rates of approximately 45 percent to 55 percent have been reported with epididymal sperm. Obviously, the results will vary among individuals because of differences in sperm and egg quality as well as the technical proficiency of the lab. Like vasal sperm, these sperm can be frozen at the time of surgery to eliminate future surgical sperm retrieval procedures.

 

Sperm Extraction: Testicular Sperm Extraction (TESE); Testicular Sperm Aspiration (TESA)

The newest of the aspiration techniques is testicular sperm retrieval. In this procedure, a small amount of testis tissue is taken by biopsy under local anesthesia. It is a breakthrough in that it demonstrates that sperm do not have to "mature" and pass through the epididymis in order to fertilize an egg. Because of their immaturity, however, testicular sperm need ICSI.

Testicular sperm extraction is indicated for patients in whom there is a blockage in the epididymis very near the testis that is either from prior surgery, infection or from birth, or a blockage within the ducts of the testes, called efferent ductules.

It also is used for men with extremely poor sperm production, in which so few sperm are produced that they cannot reach the ejaculate. Pregnancies are now routine in cases of poor sperm production, but there is some concern with the use of this sperm because in most cases the underlying condition causing the poor sperm production is still unknown. Therefore, in these cases, it must be realized that the condition which may have caused the infertility may be transmitted to the progeny.

Recently, even spermatids — round cells that eventually becomes sperm with tails — have been used to achieve pregnancies with ICSI. However, this has raised much speculation and concern about the use of genetic material from a still-evolving germ cell for clinical purposes before the system has been appropriately investigated and its genetic stability examined in animal models. Spermatid injections are currently considered experimental procedures.

One drawback of testis sperm is that is does not freeze as readily as epididymal or vasal sperm, so it is more likely that the male partner will need to undergo repeated procedures for each IVF attempt.

 

Sperm Extraction: "Mapping" the Failing Testes

First proposed in 1997, this concept addressed the issue of how to detect where ICSI-compatible, mature sperm exist within failing or atrophic testes. It was based on prior observations that sperm production can be "patchy" or "focal" within the failing testis. This led to the idea that the more sites that are sampled within the testis to look for sperm, the higher the chances of usable sperm.

Information derived from "mapping" can be used as follows:

  • To help infertile couples decide whether or not to proceed to IVF and ICSI
  • To locate and find sperm for ICSI within atrophic testes

Related Conditions

  • Infertility in Women

Intrauterine Insemination

Intrauterine insemination or IUI, as commonly known, can be considered as the first line of treatment for infertility. IUI can be useful for both male and/or female factor related infertility. Typically, indications for IUI include-

 

For male-

  • Oligoasthenoteratozoospermia i.e. men with low sperm count, or less motile sperm in the ejaculate, or having many abnormal sperm. In our experience we have found that if the total motile sperm concentration after sperm wash is less than 5 millions then the success rate is less.
  • Sexual or ejaculatory dysfunction where semen is collected using vibrator or through electro ejaculation.
  • Retrograde ejaculation, where semen enters the bladder after orgasm, instead of ejaculating out through penis.
  • Immunological factors like autoantibodies and sperm agglutination.
  • Men with highly viscous semen for prolong time, which restricts sperm movement deposited in the cervix under natural circumstances.
  • Donor sperm insemination

For female-

  • Anatomical defects of the reproductive tract, where direct coitus is not possible
  • Psychological sexual dysfunction - dysparuenia, vaginismus.
  • Cervical factors i.e. poor sperm-mucus interaction, failed post-coital test, antisperm antibodies.
  • Ovulatory dysfunction
  • Unexplained infertility
  • Minimal endometriosis

It has been universally observed that whenever IUI is combined with induction of ovulation or controlled ovarian stimulation, the success rate in the form of pregnancy is improved.

Depositing actively motile sperm free from debris, leucocytes, pus cells, and dead sperm has a significant reproductive advantage in fertilizing the released oocyte from the ovary, in the fallopian tube. During natural intercourse, semen is deposited in the vagina, motile sperm from the semen move towards fallopian tube. Out of around 100 million sperm from a ‘normal’ man deposited in the vagina, only about 1 million sperm find their way to the upper portion of the uterine cavity and only few hundred enter the tube where fertilization occurs. In IUI, 5-10 million motile sperm are deposited at the top of the uterine cavity near the opening of the tubes thus significantly increasing the chances of healthy sperm reaching the mature oocyte.

The risk of infection with IUI is very small.

In Vitro Fertilization(IVF)

In 1978, PC Steptoe and RG Edwards successfully ‘created’ human embryo out side the body after fertilizing female gamete - the oocyte using male gamete- the sperm in a test tube. Though the patient underwent this treatment had blocked fallopian tubes, subsequently clinicians found that many other indications can be effectively treated by this innovative treatment modality.

Over the past 30 years, In Vitro Fertilization has seen many changes that include continuous refinement techniques, development of patient selection criteria, and patient preparation.

 

The IVF Program

Many couples willing to have their own child are still unable to become pregnant after first line therapy such as ovulation induction, intrauterine insemination, or reproductive surgery. For these couples, the next logical step is to explore the Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) popularly known as Test Tube Baby.

IVF is a technological process where several eggs are retrieved from a woman's ovaries and then fertilized by the husband's sperm outside the body in a controlled environment of the laboratory. The fertilized eggs then develop into embryos and these are returned to the woman's uterus, by a procedure called embryo transfer.

 

Indications for ART

Both Fallopian tubes are absent, blocked or hopelessly diseased.

The husband has a reduced sperm count(Oligozoospermia)

Sperms antibodies in wife's and /or husband's serum

Endometriosis i.e. the presence of endrometrium (lining of womb) outside the uterus.

Unexplained Infertility(refer to couples in whome no obvious pathology is found but who can not conceive.

IVF also helps women who have absent ovaries or where there are no eggs in the ovaries provided any young member of the family with proven fertility is willing to donate her oocytes.

We – at Fertility Clinic- have a dedicated team with more than 25 years of experience in he field of infertility and ART. We encourage you to learn as much as you can about the IVF program at our centre. This section of the Web site offers an overview of medications, procedures, success rates and financial issues related to IVF. You will also have the opportunity to tour our state-of-the-art medical facilities, post your querries you may have related to infertility.

 

IVF Medications

It is necessary to take certain medications during the IVF cycle in order to prepare the body for the treatment. The instructions for each medication vary from patient to patient. The medical team at fertility clinic will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications and how long to take them.

 

The Preliminary Investigations are:-

For Wife:-

1) Hysteroscopy & measurement of uterocervical length.

2) Ultrasound Examination of uterus and ovaries. To exclude uterine pathology and cyst in ovaries.

3) Hormonal Profile (TSH, Prolactin, FSH & LH on 3rd day of the period).

4) CBC, ESR, Blood VDRL, Blood Sugar PP, Blood group Rh factor, Australia Antigen/HIV /HCV antibodies Bleeding Time & Clotting Time, X-Ray chest & Chlamydia antibodies

For Husband:-

1) Semen analysis.

2) Semen culture and antibiotic sensitivity test.

3) Antisperm Antibody test for husband and wife.

4) Sperm Survival test and semen harvesting.

5) Blood for Australia Antigen, HIV Antibodies, HCV Antibodies.

N.B.:- (1), (2) & (4) are valid for 3 months only.

Surrogacy Clinic

High Risk Pregnancy

The factors that place a pregnancy at risk can be divided into four categories:

  • Existing Health Conditions
  • Age
  • Lifestyle Factors
  • Conditions of Pregnancy

Existing Health Conditions

  • High blood pressure. Even though high blood pressure can be risky for mother and fetus, many women with high blood pressure have healthy pregnancies and healthy children. Uncontrolled high blood pressure, however, can lead to damage to the mother’s kidneys and increases the risk for low birth weight or
  • Polycystic (pronounced pah-lee-SIS-tik) ovary syndrome (PCOS) is a disorder that can interfere with a woman's ability to get and stay pregnant. PCOS may result in higher rates of miscarriage (the spontaneous loss of the fetus before 20 weeks of pregnancy), gestational diabetes, preeclampsia, and premature delivery.
  • Diabetes. It is important for women with diabetes to manage their blood sugar levels before getting pregnant. High blood sugar levels can cause birth defects during the first few weeks of pregnancy, often before women even know they are pregnant. Controlling blood sugar levels and taking a multivitamin with 40 micrograms of folic acid every day can help reduce this risk.
  • Kidney disease. Women with kidney disease often have difficulty getting pregnant, and any pregnancy is at significant risk for miscarriage. Pregnant women with kidney disease require additional treatments, changes in diet and medication, and frequent visits to their health care provider.
  • Autoimmune disease. Autoimmune diseases include conditions such as lupus and multiple sclerosis. Some autoimmune diseases can increase a women's risk for problems during pregnancy. For example, lupus can increase the risk for preterm birth and stillbirth. Some women may find that their symptoms improve during pregnancy, while others experience flare ups and other challenges. Certain medications to treat autoimmune diseases may be harmful to the fetus as well.
  • Thyroid disease. Uncontrolled thyroid disease, such as an overactive or underactive thyroid (small gland in the neck that makes hormones that regulate the heart rate and blood pressure) can cause problems for the fetus, such as heart failure, poor weight gain, and birth defects.
  • Infertility. Several studies have found that women who take drugs that increase the chances of pregnancy are significantly more likely to have pregnancy complications than those who get pregnant without assistance. These complications often involve the placenta (the organ linking the fetus and the mother) and vaginal bleeding.
  • Obesity. Obesity can make a pregnancy more difficult, increasing a woman’s chance of developing during pregnancy, which can contribute to difficult births.On the other hand, some women weigh too little for their own health and the health of their growing fetus. In 2009, the Institute of Medicine updated its recommendations on how much weight to gain during pregnancy. New recommendations issued by the American College of Obstetricians and Gynecologists suggest that overweight and obese women may be able to gain even less than what is recommended and still have a healthy infant.
  • HIV/AIDS damages cells of the immune system, making it difficult to fight infections and certain cancers. Women can pass the virus to their fetus during pregnancy; transmission also can occur during labor and giving birth or through breastfeeding. Fortunately, effective treatments exist to reduce the spread of HIV from the mother to her fetus, newborn, or infant. Women with very low viral loads may be able to have a vaginal delivery with a low risk of transmission. An option for pregnant women with higher viral loads (measurement of the amount of active HIV in the blood) is a ,which reduces the risk of passing HIV to the infant during labor and delivery. Early and regular prenatal care is important. Women who take medication to treat their HIV and have a cesarean delivery can reduce the risk of transmission to 2%.

Age

  • Teen pregnancy. Pregnant teens are more likely to develop high blood pressure and anemia (lack of healthy red blood cells), and go into labor earlier than women who are older. Teens also may be exposed to a sexually transmitted disease or infection that could affect their pregancy. Teens may be less likely to get prenatal care or to make ongoing appointments with health care providers during the pregnancy to evaluate risks, ensure they are staying healthy, and understand what medications and drugs they can use.
  • First-time pregnancy after age 35. Older first-time mothers may have normal pregnancies, but research indicates that these women are at increased risk of having:
    • A cesarean (pronounced si-ZAIR-ee-uhn) delivery (when the newborn is delivered through a surgical incision in the mother’s abdomen)
    • Delivery complications, including excessive bleeding during labor
    • Prolonged labor (lasting more than 20 hours)
    • Labor that does not advance
    • An infant with a genetic disorder, such as Down syndrome.

Lifestyle Factors

  • Alcohol use. Alcohol consumed during pregnancy passes directly to the fetus through the umbilical cord. The Centers for Disease Control and Prevention recommend that women avoid alcoholic beverages during pregnancy or when they are trying to get pregnant. During pregnancy, women who drink are more likely to have a miscarriage or stillbirth. Other risks to the fetus include a higher chance of having birth defects and fetal alcohol spectrum disorder (FASD). FASD is the technical name for the group of fetal disorders that have been associated with drinking alcohol during pregnancy. It causes abnormal facial features, short stature and low body weight, hyperactivity disorder, and vision or hearing problems.
  • Cigarette smoking. Smoking during pregnancy puts the fetus at risk for preterm birth, certain , and . Secondhand smoke also puts a woman and her developing fetus at increased risk for health problems.

Conditions of Pregnancy

  • Multiple gestation. Pregnancy with twins, triplets, or more, referred to as a multiple gestation, increases the risk of infants being born prematurely (before 37 weeks of pregnancy). Having infants after age 30 and taking fertility drugs both have been associated with multiple births. Having three or more infants increases the chance that a woman will need to have the infants delivered by cesarean section. Twins and triplets are more likely to be smaller for their size than infants of singleton births. If infants of multiple gestation are born prematurely, they are more likely to have difficulty breathing.
  • Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is diabetes that first develops when a woman is pregnant. Many women can have healthy pregnancies if they manage their diabetes, following a diet and treatment plan from their health care provider. Uncontrolled gestational diabetes increases the risk for preterm labor and delivery, preeclampsia, and high blood pressure.
  • Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy. It can affect the mother's kidneys, liver, and brain. When left untreated, the condition can be fatal for the mother and/or the fetus and result in long-term health problems. Eclampsia is a more severe form of preeclampsia, marked by seizures and coma in the mother.

Menstrual Problems

Are clots and thicker menstrual blood unusual during a period? continued...

Your body typically releases anticoagulants to keep menstrual blood from clotting as it's being released. But when your period is heavy and blood is being rapidly expelled, there's not enough time for anticoagulants to work. That enables clots to form.

If you have excessive clotting or clots larger than a quarter, you should see your health care provider to rule out any conditions that might be causing an abnormal period.

Are darker colors and thicker flows normal in menstrual blood?

Sometimes you may notice that your menstrual blood becomes dark brown or almost black as you near the end of your period. This is a normal color change. It happens when the blood is older and not being expelled from the body quickly.

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Blossom Infertility and Women Care Center
#221, 1st Floor,
Next to Sai Prasadam Hotel,
RPC Layout, Vijayanagar,
Bangalore - 560040

Mobile: +91 9900997330, 9900999116
Email: shwethapramodh27@gmail.com